51 healthcare institutions got P1.4-B IRM funds despite records of fraud —Congressman Defensor

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The Philippine Health Insurance Corp. (PhilHealth) has released approximately P1.4 billion to a total of 51 healthcare institutions nationwide through the interim reimbursement mechanism (IRM) despite records of fraudulent cases.

House Committee on Public Accounts chair Mike Defensor revealed the fraud  during the continuation of the House joint panel inquiry into the alleged irregularities in PhilHealth.

Defensor, citing documents submitted by PhilHealth itself, said a total of 4,664 fraudulent cases by healthcare institutions have been recorded from 2013 to 2020, of which 768 were reported from 2013 to 2018 and 3,806 were from 2019 to 2020.

The fraudulent offenses committed by healthcare institutions include padding of claims, post-dating of claims, misrepresentation by furnishing false or incorrect information, fabrication or possession of fabricated forms and supporting documents, among others, Defensor said.

But despite these fraudulent cases, 51 healthcare institutions received funding through the IRM amounting to P1,493,554,124.55, he said.

These healthcare institutions include major hospitals in Metro Manila.

Defensor also questioned why these institutions still got IRM funds even as they have a record of fraudulent cases.

“Pagpalagay natin, may nakita ako isa o dalawa, katulad nung St. Lukes, Medical City, ang pinagtataka ko bakit hindi ni-resolve ang fraud cases bago nag-release ng IRM?” he said.

Defensor expressed concern that allocating IRM funds to healthcare institutions with fraudulent cases would set a bad example.

“With so many hospitals here in Metro Manila, in other provinces, we should not allow those that have fraud cases, those that have penalties, to continue to have such funds,” he said.

PhilHealth has yet to make a comment on Defensor’s statement.

Resigned PhilHealth anti-fraud officer Thorsson Montes Keith earlier claimed that the PhilHealth “mafia,” composed of the executive committee, stole some P15 billion through fraudulent schemes, including those involving the IRM.

PhilHealth, in a statement, has denied such claims.

The agency and its officials are also under investigation over the agency’s alleged overpriced purchase of an information technology system worth over P2 billion./Stacy Ang

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